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Wisconsin Immunization Program Update

The following is an update from the Wisconsin Department of Health Services.

Measles and Travel

Lately there have been a number of international and domestic flights involving passengers with measles. This serves as a good reminder that we continue to ensure all Wisconsinites, particularly those who travel are protected. The measles-mumps-rubella (MMR) vaccine is the best way to protect individuals. Two doses of MMR vaccine provide 97% protection against measles.

The first dose of MMR should be given on or after the first birthday. A second dose of MMR is recommended to produce immunity in those who failed to respond to the first dose. The second dose of MMR vaccine should routinely be given at age 4-6 years, before a child enters kindergarten or first grade. The second dose of MMR may be administered as soon as 4 weeks (28 days) after the first dose.

Before any international travel, infants 6 through 11 months of age should have 1 dose of MMR vaccine. Children 12 months of age or older should have 2 doses, each dose separated by at least 28 days (as routinely recommended). Adolescents and adults who have not had measles or been vaccinated should get 2 doses separated by at least 28 days.

Health care providers should ensure that all personnel, including non-clinical staff and volunteers, have documented immunity to measles.

Immunity for health care personnel consists of laboratory evidence of immunity or vaccination with two doses of live measles vaccine. Birth before 1957 is not considered acceptable proof for health care personnel.

Reinforce the importance of MMR vaccination by giving a strong recommendation to all patients.

Use reminder/recall. Clinics can generate reports in the Wisconsin Immunization Registry (WIR) or your electronic health record system to determine which patients are due or overdue for MMR. Clinics can reach out to patients to schedule an appointment for immunization.

Do not miss opportunities to vaccinate patients. Use every clinical encounter to assess and offer MMR.

Place educational material in waiting and exam rooms, or add a pre-recorded message to the phone system. The CDC has many resources, such as MMR vaccine: What you should know.

All measles cases-suspected or confirmed- must be reported to the Wisconsin Division of Public Health. Measles is a Wisconsin Disease Surveillance Category I disease. Health care providers who have patients with suspected or confirmed measles should report immediately by telephone to the patient’s local health department. The local health department shall then notify the state epidemiologist immediately by calling 608-258-0099.

The recommended specimen collection and laboratory testing are as follows:

Combined throat and nasopharyngeal swabs for PCR, preferably within the first three days of illness, but no later than ten days after rash onset.

Acute serum for IgM and IgG serology obtained as soon after onset as possible.

If you have questions regarding individuals who may have been exposed or who are experiencing symptoms, please call the Wisconsin Immunization Program at 608-267-9959.

The “Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines” policy statement was published in a recent Morbidity and Mortality Weekly Report (MMWR). The statement provides background data, information, and findings related to ACIP’s recommendations for the use of Zoster Vaccine Recombinant, Adjuvanted (Shingrix) (RZV) and Zoster Vaccine Live (Zostavax) (ZVL).

These recommendations serve as an update to the existing recommendations for the use of ZVL in immunocompetent adults aged ≥60 years.

In October 2017, ACIP made the following three recommendations:

RZV is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged ≥50 years.

RZV is recommended for the prevention of herpes zoster and related complications for immunocompetent adults who previously received ZVL.

RZV is preferred over ZVL for the prevention of herpes zoster and related complications.

Please note, that the acronym for Zostavax has been standardized as “ZVL.”

The Wisconsin Immunization Registry (WIR) team is working to implement the new recommendation within the WIR. Once it has been implemented, notification will be sent out that the change has been made.

It's Not Too Late to Vaccinate Against Influenza

According to the Wisconsin Weekly Respiratory Report cases of influenza like illness continue to rise across the state with 646 flu related hospitalizations reported just in the week ending January 20, 2018. Additionally, data from the Wisconsin Immunization Registry (WIR) indicates that only 33% of Wisconsin residents have received the flu vaccine, leaving the majority of residents unprotected.

Remember that it is not too late to vaccinate your patients against influenza. The Centers for Disease Control and Prevention Influenza web page includes resources and materials for providers and patients to encourage vaccination.